What to ask inurance companies when checking coverage...
When I called my RE's office today the receptionist mentioned that we may move me up to injectibles in the next couple of cycles.
I have no idea what is and is not covered by my insurance. I am going to be calling them today or tomorrow to find out.
For those of you who have been through this, what kind of questions should I ask? All I can think of is "what is covered, what is not?" but I know insurance companies dont offer much info up front if you dont ask for it specifically so I am wondering what specific questions I should ask...
__________________ 5 Clomid. 2 unmedicated and 2 Femara cycles: O'd 7-BFN Follistim Cycle #1 w/Timed Intercourse: BFP! 11/1/09 11dpo To view links or images in signatures your post count must be 0 or greater. You currently have 0 posts.
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Mine was pretty up front when I asked, "What fertility tests and treatments do you cover?" They listed the names of the tests for me and gave me time to write them down. Good luck!
__________________ Sarah (29) & Michael (29)
Married 6/22/07
8/30/09: BFP! (150mg Clomid, 2000mg Metformin, IUI)
Beta #1 (14dpo) - 165; Beta #2 (16dpo) - 290
EDD: May 12, 2010
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really? That gives me a little hope. I've been told its like pulling teeth!
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Yeah mine was easy! Too bad they didn't cover much, though (initial consultation, semen analysis, HSG, and endometrial biopsy - THAT'S IT. Not even bloodwork coded as infertility would be covered).
__________________ Sarah (29) & Michael (29)
Married 6/22/07
8/30/09: BFP! (150mg Clomid, 2000mg Metformin, IUI)
Beta #1 (14dpo) - 165; Beta #2 (16dpo) - 290
EDD: May 12, 2010
IT'S A GIRL!
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Thanks for starting this thread. I, myself, might be moving on to injects in a few months if no bfp on Femara. I'd like to know how to ask that question as well, and can they code any of it as PCOS (not sure how you could code fertility meds as PCOS!).
__________________ TTC 12/07
DX 12/08
M/C 3/08, 4/09, 11/09 But these things I plan won't happen right away. Slowly, steadily, surely, the time approaches when the vision will be fulfilled. If it seems slow, be patient! For it will surely take place. It will not be late by a single day.
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Don't ask your insurance company about coding things differently. Make sure you tell your doctor EXACTLY what insurance will cover. They can hopefully help you by coding blood work as something other than infertility. You're right, though, that injects probably won't be covered no matter what.
__________________ Sarah (29) & Michael (29)
Married 6/22/07
8/30/09: BFP! (150mg Clomid, 2000mg Metformin, IUI)
Beta #1 (14dpo) - 165; Beta #2 (16dpo) - 290
EDD: May 12, 2010
IT'S A GIRL!
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Don't ask your insurance company about coding things differently. Make sure you tell your doctor EXACTLY what insurance will cover. They can hopefully help you by coding blood work as something other than infertility. You're right, though, that injects probably won't be covered no matter what.
So glad you said it...my advice was to just question your insurance about fertility treatments. Don't say anything else about coding. That would be a red flag for them.
My dr. is really good about coding things so insurance doesn't get upset.
Hopefully the insurance stuff works out for you.
__________________ Haley (29) To view links or images in signatures your post count must be 0 or greater. You currently have 0 posts. DH (30) Married 11/29/08
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My insurance does cover the injectibles. When you call just ask about you inferiltity benefits, maximums, deductibles, copays for injectibles, whether they are covered under the medical (mine are) or your prescription plan. I work for a large insurance company, and I used to quote benefits for a living To view links or images in this forum your post count must be 10 or greater. You currently have 0 posts. ......Some companies will even allow you to give them the drug name to look it up for you. Just take as much time as you need to make sure you understand your benefits fully, if they are a good rep they should be more than happy to help you with this To view links or images in this forum your post count must be 10 or greater. You currently have 0 posts. Good luck!
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Sorry if I wasn't clear. I meant tell the doc office to code things differently. I'm certain asking insurance companies would throw up major red flags.
I'm just terrified to call - I imagine them recording the full conversation, even if you're asking "what if" questions, to use as ammo for denying anything in the future.
__________________ TTC 12/07
DX 12/08
M/C 3/08, 4/09, 11/09 But these things I plan won't happen right away. Slowly, steadily, surely, the time approaches when the vision will be fulfilled. If it seems slow, be patient! For it will surely take place. It will not be late by a single day.
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Your insurance won't use questions you ask against you To view links or images in this forum your post count must be 10 or greater. You currently have 0 posts. And just think of it this way, it is better to be prepared then to be scrambling for answers when you have to know right away!
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TTC since 12/01/2007
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I called and they said I have a $15,000 lifetime maximum on infertility. That covers IUI, IVF, ICSI and any other ART's.
My prescription plan is through medco. I checked online and put through a sample order for gonal-f and this is what I got:
Quote:
Gonal-F RFF PEN 900iu Pen Injctr
Dosage: 30 1.500ml crtrdg-ndl, per month
$50.00 for 90 days supply
Not sure if there are any limits... but if this is accurate I think I just got wonderful news!
__________________ 5 Clomid. 2 unmedicated and 2 Femara cycles: O'd 7-BFN Follistim Cycle #1 w/Timed Intercourse: BFP! 11/1/09 11dpo To view links or images in signatures your post count must be 0 or greater. You currently have 0 posts.
It's a BOY!
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I looked at my benefits online a while back and it said no infertility coverage. I was hoping to call them, and maybe I'd get a different answer, or be an exception to their rule!
__________________ TTC 12/07
DX 12/08
M/C 3/08, 4/09, 11/09 But these things I plan won't happen right away. Slowly, steadily, surely, the time approaches when the vision will be fulfilled. If it seems slow, be patient! For it will surely take place. It will not be late by a single day.
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I'm trying not to get too excited just in case I am misunderstanding something! But right now it does look good. Keeping my fingers crossed that I am understanding everything right!
__________________ 5 Clomid. 2 unmedicated and 2 Femara cycles: O'd 7-BFN Follistim Cycle #1 w/Timed Intercourse: BFP! 11/1/09 11dpo To view links or images in signatures your post count must be 0 or greater. You currently have 0 posts.
It's a BOY!
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What to ask inurance companies when checking coverage... 
